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NBME 24 Answers

nbme24/Block 3/Question#49
A 20-year-old woman with asthma comes to the ...
Ask the roommate not to smoke in the apartment🔍

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The poodle is hypoallergenic, and a 10/10 good boy.

medguru2295  For some reason, I can't upvote. But UPVOTEEEEE. Dogs are life! +  

 +6  upvote downvote
submitted by yotsubato(646),

Cold air induces asthma attacks.

Decreasing course load wont help

Taking steroids is too much for now

Moving back to the dorms is not viable

Air cleaners dont work enough

Dont get rid of the Good Boye

Smoking indoors is disgusting

sherry  Stress can actually be a trigger for asthma. I think the problem here is that she has alwasys carried a heavy course, while the disease just started recently. +4  
medguru2295  Stress makes asthma worse. Therefore, keep doggo for stress relief! +  
qiss  Also her symptoms started 3 months ago and she moved in with a roommate who smokes indoors 3 months ago. +  

 +2  upvote downvote
submitted by dragon3(9),

I almost picked asking the roommate not to smoke in the apartment, but then I figured that's beyond the scope of the doctor... another person said taking steroids would be too much for now, and I suppose that's because the asthma is well-controlled with her inhaler rn? (that's what I had picked)

sherry  I would say the patient's asthma only got worse after her moving out. So its more allergen-related. Getting rid of the allergen is always better than upgrading medications. +2  
et-tu-bromocriptine  Rippp the "don't be a dick" strategy definitely failed me on this one. For some reason, I thought requesting the patient to ask someone else to change their smoking habits would be a tad too much. I can just picture UWorld smacking me with a "Although it is likely that the roommate's cessation of smoking could alleviate the patient's asthma exacerbations, this request would be out of the physician's scope....etc." +26  
peqmd  Depends who's dickier the doctor telling the patient she shouldn't live in smoke or some guy smoking in the house +  

So we are just supposed to know that poodles are hypoallergenic...

I put "get an air cleaner" because I thought asking the roommate to stop smoking would be beyond the scope of the physician and since I didnt know poodles were hypoallergenic, I thought "well, even if the roommate stopped smoking, she'll still have issues because of the pet dander."


luciana  Same here, I got confused because it seemed that the smoke AND the dog were the triggers, so I picked "Move back to the dormitories" so all the triggers would be gone. Who would imagine poodles were hypoallergenic +  
luciana  For those like me who didn't know there was 1 hypoallergenic dog, there are 23 to you memorize :) https://blog.homesalive.ca/dogs-that-dont-shed-23-hypoallergenic-dog-breeds +  

 +1  upvote downvote
submitted by lilmonkey(16),

Always chose smoking if you see it. In any type of question. Don't even read :)

 +1  upvote downvote
submitted by whoissaad(48),

What guarantee do we have that the roommate is going to stop smoking in the apartment by "asking" him to do so..?

krewfoo99  There is no guarentee. They are basically asking what a trigger is for her asthma recurrence. Smoking in this scenario can be the cause of this patients symptoms. Dont dwell to deep into the question. +1  

I honestly don't understand why A is the correct answer. I picked "move back to the dorm" because there are three asthma triggers in her dorm: (1) the smoker, (2) the fact that her roommate doesn't like it when it's too warm (she doesn't want to be cold, and cold is a trigger for asthma), and (3) the stress of people who don't clean their dishes. Stress, cold, and smoke. Those are triggers for asthma that are present in her apartment. Is anyone else not seeing this?

123ojm  Because presumably she's already signed a lease and cannot afford to pay a second rent by moving back into the dorms. I think this goes back to making suggestions for our patients that are reasonable for them to achieve. +  
123ojm  Also her roommate is the one that makes it warm, so the apartment is not cold +  

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